Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011, China.
Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang, China.
Sci Rep. 2024 Oct 4;14(1):23100. doi: 10.1038/s41598-024-74295-7.
PCOS is one of the most common endocrine disorders among women of reproductive age. While the mechanism involved is not yet fully characterized. Our study aims to examine the pregnancy outcomes of embryo transfers in women with PCOS after pretreatment, and to explore the possible effect of high androgen levels on endometrial receptivity. Retrospective cohort study was conducted to analyze pregnancy outcomes among 2714 infertile women with tubal factor and 452 PCOS women. Endometrium samples were collected from 6 controls and 6 PCOS patients to detect the expression of endometrial receptivity marks. The implantation rate, clinical and ongoing pregnancy rates and live birth rate in women with PCOS followed fresh embryo transfers were obviously decreased even after the pretreatment. Similar pregnancy outcomes were found in frozen-thawed embryo transfer cycles between women with or without PCOS. Strikingly, serum total testosterone (TT) levels on trigger day were significantly higher in PCOS women. Women with high TT levels presented significantly lower clinical and ongoing pregnancy rates, and the expression of insulin-like growth factor binding protein 1 (IGFBP-1), and leukemia inhibitory factor (LIF) in the endometria decreased significantly as well. High doses of testosterone significantly down-regulated the expression of IGFBP-1 and LIF in Ishikawa cells. Although endocrine abnormalities had been improved before the controlled ovarian stimulation (COS) cycle started, higher serum TT levels were detected on the trigger day of the COS cycle in PCOS patients, which may contribute to the decreased fresh embryo implantation by impairing endometrial receptivity.
多囊卵巢综合征（PCOS）是育龄妇女中最常见的内分泌疾病之一。尽管其涉及的机制尚未完全阐明，但我们的研究旨在探讨预处理后 PCOS 患者胚胎移植的妊娠结局，并探索高雄激素水平对子宫内膜容受性的可能影响。
我们进行了一项回顾性队列研究，分析了 2714 例输卵管因素不孕妇女和 452 例 PCOS 妇女的妊娠结局。采集了 6 例对照和 6 例 PCOS 患者的子宫内膜样本，以检测子宫内膜容受性标志物的表达。
即使经过预处理，PCOS 患者行新鲜胚胎移植后的胚胎着床率、临床妊娠率和活产率明显降低。在冻融胚胎移植周期中，PCOS 患者和非 PCOS 患者的妊娠结局相似。令人惊讶的是，PCOS 患者的触发日血清总睾酮（TT）水平明显升高。TT 水平较高的患者临床妊娠率和持续妊娠率明显降低，子宫内膜中胰岛素样生长因子结合蛋白 1（IGFBP-1）和白血病抑制因子（LIF）的表达也明显降低。高剂量睾酮显著下调了 Ishikawa 细胞中 IGFBP-1 和 LIF 的表达。尽管在开始控制性卵巢刺激（COS）周期前内分泌异常得到改善，但 PCOS 患者在 COS 周期的触发日仍检测到较高的血清 TT 水平，这可能通过损害子宫内膜容受性导致新鲜胚胎着床减少。
